Health Committee on Sept. 27th, 2022

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

It's for you, Dr. Roy.

[Dr. Marie-Claude Roy]

I entirely agree with Dr. Feldman's remarks.

Personally, I'm obviously in favour of prevention and having more professionals. Both my colleagues also mentioned that.

I think that the share allocated to childhood should be far more than 25%. As regards mental health, what ensures a positive future for an adolescent or adult is first and foremost having the tools to help us address mental health issues.

If we invest more in mental health prevention for children and adolescents right now, the entire population will benefit. So I wouldn't simply go on a per capita basis. Most of that money should be invested in mental health prevention for children and adolescents.

As Dr. Feldman said, we're currently trying to solve the problem with medication because we lack resources. We medicalize problems when patients should be supported from a very early age.

We'll very likely reap the benefit of investments made in support, therapy and, especially, tools of all kinds in 10, 15 or 20 years. Individual therapy won't necessarily be for the long term.

Prevention programs must be put in place. We have to take a generational approach to preventing mental health problems.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Roy.

Next, we have Mr. Jowhari, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to all the witnesses for coming today.

I'm going to begin with Ms. Gruenwoldt.

In your opening remarks you talked about an initiative that was launched called “inspiring healthy futures”. You talked about five interlinking priorities. I noticed you ran out of time to be able to cover all those priorities. There were a number of them that stood out in my mind. We've been actually talking a lot about mental health.

Can you briefly talk about the research data collection and the sharing of data? As one of the interlinking recommendations, could you give us some background?

[Emily Gruenwoldt]

Sure. I think right now, if we look across the country, different data elements related to children's health are being collected by different jurisdictions. They have different levels of access for folks like researchers, or for program and service providers and policy-makers. We're looking for more of a robust, continuous, integrated data strategy that would be accessible to all those different communities to help us make better, evidence-informed, more timely decisions for children and youth.

Throughout the “inspiring healthy futures” consultations, we heard a number of calls to action. We agree that Canada needs to develop and implement a consistent, comprehensive dataset, regardless of where services are provided, which is comparable across different jurisdictions, whether it's health, health care or health outcomes, and linked to our education data as well. We also need to ensure that the folks who are impacted by this data are included in the design of the data and that we respect indigenous data sovereignty.

The third element is that we need to make sure, as I said, that all of this data is accessible to the different stakeholders who can make use of it, so that it is supporting evidence-based decisions.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

In the closing part of your remarks, you talked about bold leadership and commitment from the government. Can you elaborate on what you meant by “bold leadership”, and what kind of commitment you are looking for from all levels of government, specifically the federal government?

[Emily Gruenwoldt]

To begin with, this is a great opportunity that we have today to discuss children's health and well-being. This opportunity hasn't existed in several decades, as far as I'm aware, so the opportunity to think about a pan-Canadian child and youth health strategy is timely and urgent, I would argue.

In terms of a bold strategy, we need to think about how we are investing in policies and programs that support children, youth and their entire families, and how we make further investments, for example, in maternal and parental leave, children's benefits and the access to programs and services that exist.

We also need to be attentive to and respect the vision that children and youth have for their future. What we learned through the “Inspiring Healthy Futures” report is that they have a very clear vision and some very clear ideas and ambitious goals about what they would like to see in terms of opportunities to support their health and well-being. I think that is important. Inviting youth to this committee would be a great start, to hear from them directly on what some of those options might be.

Lastly, to be accountable, we need targets, measures and instruments that will hold the federal government, the provincial governments and organizations like mine to account, so we know that we're making meaningful and measurable progress for children and youth. Whether that's the idea of an independent accountability office or a commissioner or otherwise, that sort of leadership would be welcome at this time.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I'm going to move on to Dr. Feldman.

Dr. Feldman, you were talking about CBT and early intervention, and that being a method of making an early impact in a much shorter time frame than other prescribed methods.

Can you expand on that? You ran out of time while trying to cover that point. I have about a minute, and I'm going to give that to you to finish that thought.

[Dr. Mark Feldman]

Thank you.

Services offered by psychologists for the younger children that are currently not publicly funded are really about assessment for learning, behavioural and development issues. There are small amounts that are publicly funded through schools, but the wait-lists are untenable.

Services for kids who are a little bit older that psychologists or other health disciplines trained in the delivery of CBT provide are similarly very difficult to access, and generally speaking are not publicly funded.

CBT is an evidence-based therapy that makes a considerable difference in terms of function and quality of life for kids with anxiety and depression. CBT is first-line therapy, and medications like Prozac are second-line therapy, but often they're started first because we can't get a psychologist.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Feldman and Mr. Jowhari.

Mr. Villemure, you have the floor for two and a half minutes.

[René Villemure, Bloc, Trois-Rivières, QC]

Good afternoon, Mr. Chair. Thank you.

My question is also for Dr. Roy.

Dr. Roy, did the provinces and territories take the same pediatric health approach during the pandemic?

[Dr. Marie-Claude Roy]

The pandemic actually landed on everyone's head like a ton of bricks. I think you could put it that way. We had to make an enormous number of adjustments and adapt to the situation. We've talked about leadership, exchanging approaches and sharing topics of concern. That's Canada's strength, and we have to remember that.

Earlier I talked about Ontario, but, in Quebec, we immediately recommended that children go back to school, knowing that COVID‑19 wasn't a serious threat to them. It was a calculated risk. We knew that, since the pandemic seemed to be dragging on, and is still with us today, the impacts on children's health would be drastically greater if we decided to limit school attendance, the social safety net, financial and food support and measures designed to limit family violence.

We had numerous discussions with our Ontario colleagues, who were concerned that children weren't going back to school. We had discussions with the Canadian Paediatric Society. The approaches were different, first of all because fears varied considerably from coast to coast and province to province. Populations and health systems reacted differently. However, we communicated with everyone and gathered assets and ideas from everywhere. It was a great way to work.

So approaches were different, but we've managed to improve how we work together. I'm thinking, in particular, of the long-term residential care centres, the CHSLDs. We drew on certain models in Quebec because we felt that things weren't going well in that area. The situation was much better in British Columbia, for example. Even though approaches were different, it was this variety of methods and pooling of approaches that enabled us to move all the provinces forward.

[René Villemure, Bloc, Trois-Rivières, QC]

I believe that this wide range of interesting approaches you've mentioned shows that we should be learning from other provinces, while still allowing them to choose the therapies or other measures they would like to adopt.

Don't you agree?

[Dr. Marie-Claude Roy]

Each of the provinces would benefit, and then collectively, so would the federal government. A single recipe would not work. That was clearly demonstrated during the pandemic response, which reflected the diversity of the population's needs from one region to another in Quebec, and also from province to province across Canada.

[René Villemure, Bloc, Trois-Rivières, QC]

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you very much.

Mr. Davies, you have two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Ms. Gruenwoldt, I asked you at the end of my last round to answer why Canada is 35th out of 38 in adolescent suicides. What are the causes of that?

[Emily Gruenwoldt]

I'm not a mental health practitioner, but we do know that children and youth have struggled in academic environments. Being in and out of school over the course of the pandemic has likely served to stress a particular population of children who weren't thriving in the at-home environment. There are lots of risk factors at home for some of those children as well.

Otherwise, the support and community based services—which are either preventative or early intervention services—largely aren't available or accessible. The two-and-a-half year wait is a very long time to wait for a child or youth and their family when they're suffering from mental health concerns.

I would also say, to Dr. Feldman's point earlier, that the opportunity to train our general practitioners, pediatricians and some of those frontline health care providers to earlier identify concerns and diagnose and refer is a great place to start. We also need to think about how we deliver access to children who are rural, remote, indigenous, new Canadians or not English first, etc.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Feldman, in your practice or among other pediatricians, I'm curious about the extent to which you see a lack of access to universal dental care manifesting in children. Is that a significant oral health issue in Canada?

[Dr. Mark Feldman]

Yes, I do think it's an issue. It's not my area of expertise, but certainly when I looked at the first meeting of this committee, I found the concerns raised by the dental association leads quite compelling.

Although I'm a general pediatrician, my practice is now more specialized in kids with mental health and learning issues.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have any explanation for why we seem to have a burgeoning crisis in adolescent suicide in Canada? What are the causes of that?

[Dr. Mark Feldman]

A lot of this is conjecture. The numbers are there, but much more research needs to be done. There's been a huge rise in eating disorders during the pandemic. I think the access issues that were just spoken about are going to turn out to be a really big part of that.

For example, kids with ADHD are more likely to commit suicide if they're not treated. In fact, specific treatment for their ADHD, not simply depression or anxiety, reduces the impulsivity and the likelihood of suicide.

I think the isolation that we all experienced through the pandemic must have played a role.

There are so many different theories, but further research into this area needs to be done. Certainly we need to address the access issue now, but more research and more targeted approaches are needed.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Feldman and Mr. Davies.

Next is Ms. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

Thank you to all the witnesses for your testimony today.

Something that I'd like to touch on is something that's been pretty active in the news as of late. It's something that I know touches a lot of parents and is causing a lot of stress. That's the shortage we're seeing in children's Tylenol, Advil and Motrin, specifically in the infant formulations.

I was wondering if you have anything to add, or is there anything that the Government of Canada could do to try to alleviate some of the shortages and diminish the stress that so many families are seeing?

I see Ms. Roy shaking her head.

Would you like to go ahead, Ms. Roy?

[Dr. Marie-Claude Roy]

Yes, thank you.

I'm shaking my head because that situation and the milk shortage became a major problem.

We worked hard on the issue during the shortage of hydrolyzed formulas for infants with an intolerance to cow's milk proteins. The same was the case for Tylenol and Advil. Worker shortages were frequent, I believe, and we also ran short of all kinds of things other than medications.

It's clear that the federal government can help us by reaching out to other countries, like Europe and other markets. Of course we need to restrict ourselves to what's approved here in Canada.

Nevertheless, versatility, flexibility and the ability to adapt quickly were clearly in evidence during the pandemic. This kind of flexibility is essential for us. When you start running short of very specific medications for children, then I think other options have to be available. It's important to be able to resort to international solutions to at least attenuate the impact of the whole situation, which was very difficult for many parents.